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Premenstrual Dysphoric Disorder (PMDD)

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) is a much more severe form of premenstrual syndrome (PMS). It may affect women who are able to get pregnant. It’s a severe and chronic medical condition that requires attention and treatment.  Lifestyle changes and sometimes medications can help manage symptoms.

What causes PMDD?

The exact cause of PMDD is not known. It may be an abnormal reaction to normal hormone changes that occur with each menstrual cycle. The hormone changes can cause a serotonin deficiency. Serotonin is a substance found naturally in the brain and intestines that narrows blood vessels and can affect mood and cause physical symptoms.

What are the risk factors for PMDD?

While any woman can develop PMDD, the following may be at an increased risk:

  • Women with a family history of PMS or PMDD  
  • Women with a personal or family history of depression,  postpartum depression, or other mood disorders

Other possible risk factors include lower education and cigarette smoking

Consult your health care provider for more information.

What are the symptoms of PMDD?

Symptoms of PMDD appear during the week before and end within a few days after your period starts. These symptoms disrupt daily living tasks. Symptoms of PMDD are so severe that women have trouble functioning at home, at work, and in relationships during this time. This is markedly different than other times during the month.

The following are the most common symptoms of PMDD:

Psychological symptoms

  • Irritability
  • Nervousness
  • Lack of control
  • Agitation
  • Anger
  • Insomnia
  • Difficulty in concentrating
  • Depression
  • Severe fatigue
  • Anxiety
  • Confusion
  • Forgetfulness
  • Poor  self-image
  • Paranoia
  • Emotional sensitivity
  • Crying spells
  • Moodiness
  • Trouble sleeping

Fluid retention

  • Swelling of the ankles, hands, and feet
  • Periodic weight gain
  • Diminished urine output
  • Breast fullness and pain

Respiratory problems

  • Allergies
  • Infections

Eye complaints

  • Vision changes
  • Eye infection

·       

Gastrointestinal symptoms

  • Abdominal cramps
  • Bloating
  • Constipation
  • Nausea
  • Vomiting
  • Pelvic heaviness or pressure
  • Backache

Skin problems

  • Acne
  • Skin inflammation with itching
  • Aggravation of other skin disorders, including cold sores

Neurologic and vascular symptoms

  • Headache
  • Dizziness
  • Fainting
  • Numbness, prickling, tingling, or heightened sensitivity of arms and/or legs
  • Easy bruising
  • Heart palpitations
  • Muscle spasms

Other

  • Decreased coordination
  • Painful menstruation
  • Diminished sex drive
  • Appetite changes
  • Food cravings
  • Hot flashes

·       

The symptoms of PMDD may look like other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder. Always consult a health care provider for a diagnosis.

How is PMDD diagnosed?

Aside from a complete medical history and physical and pelvic exam, there are very few diagnostic tests. Because there are mental health symptoms, your doctor may want you to be evaluated for mental health concerns. In addition, your doctor may ask that you keep a journal or diary of your symptoms for several months. In general, to diagnose PMDD the following symptoms must be present:

  • Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:
    • Depressed mood
    • Anger or irritability
    • Trouble concentrating
    • Lack of interest in activities once enjoyed
    • Moodiness
    • Increased appetite
    • Insomnia or the need for more sleep
    • Feeling overwhelmed or out of control
    • Other physical symptoms, the most common being abdominal bloating, breast tenderness and headache
  • Symptoms that disturb your ability to function in social, work, or other situations
  • Symptoms that are not related to, or exaggerated by, another medical condition

How is PMDD treated?

PMDD is a serious, chronic condition that does require treatment. Several of the following treatment approaches may help relieve or decrease the severity of PMDD symptoms:

  • Changes in diet  to increase protein and carbohydrates and decrease sugar, salt, caffeine, and alcohol
  • Regular exercise
  • Stress management
  • Vitamin supplements (such as vitamin B6, calcium, and magnesium)
  • Anti-inflammatory medications
  • Selective serotonin reuptake inhibitors (SSRI)
  • Birth control pills

For some women, the severity of symptoms increase over time and last until menopause. For this reason, a woman may require treatment for an extended time. Medication dosages may be needed throughout the course of treatment.

Key points

PMDD is a much more severe form of t premenstrual syndrome (PMS).

The exact cause of PMDD is not known.

  • The main symptoms that distinguish PMDD from other mood disorders or menstrual conditions is the when symptoms start and how long they last.
  • Symptoms of PMDD are so severe that it affects your ability to function at home, work and in relationships.
  • Aside from a complete medical history and physical and pelvic exam, there are very few tests to diagnose the condition.
  • Over the course of a year, during most menstrual cycles, 5 or more of the following symptoms must be present:
    • Depressed mood
    • Anger or irritability
    • Trouble concentrating
    • Lack of interest in activities once enjoyed
    • Moodiness
    • Increased appetite
    • Insomnia or feeling very sleepy
    • Feeling overwhelmed or out of control
  • PMDD is a serious, chronic condition that does require treatment that may include lifestyle changes and sometimes medications.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

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